The rollout of the Affordable Care Act (ACA) has been a disaster and President Barack Obama acknowledges it. About the only thing separating the scale of this administration-threatening failure from the Hurricane Katrina debacle is people dying in the latter.
Since a) most every American is aware of this, b) it involves one-sixth of our economy, and c) virtually everyone will be directly or indirectly affected by the ACA – or “Obamacare” – we might as well use it as a teachable moment for leaders. As they say, a crisis is a learning opportunity and this is a big one.
The 2010 law drips with politics on both sides which I will try to sidestep and concentrate on the crisis management instead.
The “Commander” should have eyes-on the action
First, it seems almost beyond comprehension that a law so sweeping, so central to the perception of a presidency – its signature legislative accomplishment – and so complicated could be permitted to be so poorly implemented. How is it conceivable that with three years notice the primary website gateway for people to check out and/or apply for new health insurance policies would crash on day one, week one, month one? Insiders testified they foresaw the “train wreck” seven months earlier. If the implementation of the ACA were the Invasion of Normandy can you imagine the outcome of D-Day? Of World War II?
Speaking of the military let me draw upon US Marine Corps command and control doctrine for the first leadership lesson.
Marine commanders are taught that they can’t hole up in a command post during major military action. Sometimes they must get close enough to the battle to be able to personally observe what is happening. That enables them to draw upon their own experience and insight to gauge the true status of events. They can see how the actual situation compares with the “desired end state” and adjust tactics accordingly. Given the practical and political stakes of implementation of the Affordable Care Act the President or at least his Secretary of Health and Human Services should have gotten sufficiently close to the preparations to be certain that ACA would work. Did they?
I suspect that if you were unveiling a corporate-defining program of magnitude at your company that you, as a leader, would put eyes-on the run-up to ensure a successful start.
Act to reassure followers they will be “safe”
Whether the ACA ultimately succeeds or fails, this initial bungling has become presidency-defining. Can one watch the parade of bad news, apologies, and stupefying miscalculations and maintain trust in an administration’s capacity to implement any program? This is particularly bad with the Affordable Care Act because this law involves two matters viscerally important to the public: their money and their health. Threaten either and you get what we’ve got: plummeting support for the President by citizens and by some members of his own party reacting to alarmed constituents. When trouble strikes, people want to know, “Am I safe?” The dreadful implementation of the Act could hardly reassure them that they are.
In the days when HMO’s dominated health care, a vice president asked me why the media and others beat up on his industry so regularly. I told him some HMO practices made patients feel unsafe, vulnerable. The Affordable Care Act is currently in that league. Not only does financial and healthcare uncertainty unnerve many, the very failure of government at such magnitude undermines faith in the institution itself.
Establish a feedback loop
Implementing major programs or introducing new products challenges leaders. They must have continuous reliable feedback from those in the trenches who will make it materialize. A critical cog in that information flow is stakeholders. Re-imagining this country’s healthcare system relies on the input of those who make it happen or have a stake in the outcome: insurance companies, state insurance commissioners, hospitals, physicians, Medicare/Medicaid, etc. When the President modified ACA’s implementation to ensure people could “keep insurance plans they like” he made the shift without consulting insurance companies and commissioners who must execute the 180-degree turn practically overnight.
And, speaking of the feedback loop, news stories repeatedly raise serious questions about whether the Affordable Care Act will work. To ensure it does the President will desperately need truth-tellers to give him the facts from the “front” so he can adapt to the inherent uncertainty of this enterprise.
Most agree America’s healthcare system needs fixing. History shows that previous large-scale programs like Social Security and Medicare stumbled out of the gate and took years to fine-tune. At first, I assumed the Affordable Care Act’s troubles were this pattern repeating itself. I also considered the website roll-out failures a reflection of typical federal project management where new programs are sliced and diced to give as many government contractors as possible a piece of the billions being spent. Both assumptions may still prove correct but a CEO would be fired over this kind of catastrophe. And woe unto all of us if this law collapses from the weight of a leadership vacuum.